ABSTRACT
This study assessed the influence of maternal breastfeeding practices on the anthropometric status of their infant (0-12 months) in Arochukwu L.G.A. A total of 250 mothers were selected using simple random sampling technique. Data on socio-economic/demographic characteristics, knowledge, attitude and practice of mothers towards exclusive breastfeeding, factors that influence maternal breastfeeding. Anthropometric measurements of weight and height were taken using standard procedures. The IBM SPSS version 20 computer programme was used to analyze the data. WHO anthro software was used to compute the anthropometric status of the children (0-12 months). About 38.4% of the mothers are aged between 20-24 years while majority (62.5%) of the mothers are married. About (73.2%) of the mothers earn below N20,000 monthly. Slightly below half (42.4%) of mothers exclusively breastfed their babies while about 33.2% of the children were put to breast within 30mins after birth. About 42.4% of the mothers breastfeed their baby for about 0-6 months before introducing other semi-solid foods. Half of the mothers (53.6%) have a good knowledge of exclusive breastfeeding; some (41.2%) have poor knowledge of exclusive breastfeeding, while a few (5.2%) have an excellent knowledge of exclusive breastfeeding. About (33.6%) of the mothers fed their baby with infant formula while a few (24.8%) of them fed their babies with breast milk after delivery. Majority (71.2%) feed their child 3-4 times, 48% gave their child solid, semi-solid or soft food, and 50.4% did not feed from feeding bottle. The results showed that most of the infant had normal length for age (43.2%), weight for age (47.6%), weight for length (31.2.0%) and BMI for age (47.2%) status. The percentage of stunting was considerably high (56.8%), underweight status of infant using weight for age (40.4%), weight for length (15.2%) and BMI for age (17.2%). The high levels of malnutrition in this present day underline the great need for nutritional intervention. Exclusive breast feeding and timely introduction of appropriate complementary feeding is a key factor in child growth. The assessment of nutritional status using stunting, wasting, and underweight for children shows that the children were stunted, wasted, and underweight and this may be as a result of poor feeding and complementary practices coupled with poor economic status of the parents.
TABLE OF CONTENTS
Title page i
Certification ii
Dedication iii
Acknowledgement iv
Table of content v
Lists of tables vii
List of figures viii
Abstract ix
CHAPTER 1
1.0 Introduction 1
1.1 Statement of problem 5
1.2 Objectives of the study 6
1.2.1 General objective 6
1.2.2 Specific objectives 7
1.3 Significance of study 7
CHAPTER 2
LITERATURE REVIEW 8
2.1 History of breastfeeding 8
2.2 Meaning of breastfeeding 9
2.3 Concept of breastfeeding 10
2.4 Global prevalence of exclusive breast feeding 11
2.5 Composition of breast milk 15
2.6 Maternal nutrition 20
2.7 Complementary feeding 22
2.8 Advantages of breastfeeding 23
2.8.1 Benefits to infant 23
2.8.2 Contribution to maternal health 25
2.8.3 Economic benefits 26
2.8.4 Factors that militate against breastfeeding 27
2.9 Infant feeding practice 29
2.9.1 Breastfeeding practice 29
2.9.2 Complementary feeding practice 31
2.9.3 Challenges in infant feeding practices 32
2.9.4 Hygiene and sanitation 34
2.9.5 Feeding in difficult circumstances 35
2.10 Attitude to infant feeding 37
2.10.1 Maternal attitude and beliefs in developing countries 37
2.10.2 Maternal attitudes and belief in developed countries 38
2.11 Factors affecting exclusive breastfeeding in Nigeria 39
2.12 Infant anthropometry and breastfeeding 41
2.13 The new who growth reference 44
CHAPTER 3
MATERIALS AND METHODS 48
3.1 Study design 48
3.2 Study area 48
3.3 Sample population 49
3.4 Sample size 49
3.5 Sampling and sample technique 50
3.6 Consent and permission 50
3.6.1 Recruitment and training of field assistant 51
3.7 Data collection instruments and methods 51
3.7.1 Questionnaire 51
3.7.2 Anthropometric measurement 52
3.8 Data analysis 53
3.9 Statistical analysis 54
CHAPTER FOUR
RESULT AND DISCUSSION 56
4.1 Socio-economic characteristics of the respondents 56
4.2 Mothers knowledge of exclusive breastfeeding 59
4.3 Factors that affect maternal breastfeeding practices 61
4.4a Mothers practices on exclusive breastfeeding 64
4.4b Mothers practices on exclusive breastfeeding 68
4.4c Mothers knowledge on complementary foods 71
4.5. Mothers attitude on breastfeeding 75
4.6 Infant feeding frequency 79
4.7 Summary of the anthropometric of the infant 81
4.7.1 Anthropometric measurement of the children by sex 81
4.7.2 Anthropometric measurements of the infants by age 88
4.8 The relationship between breastfeeding practices and
anthropometry measurement of the infants 91
CHAPTER 5
5.1 Conclusion 95
5.2 Recommendation 96
REFERENCES 97
APPENDIX 111
LIST OF TABLES
Table 2.1: Exclusive breastfeeding and median duration of breastfeeding a global and regional overview 14
Table 2.2: Top 5 countries for breastfeeding 14
Table 2.3: Comparative nutritive value of human milk and cow’s milk nutrient per 100g of fluid milk 19
Table 4.1: Personal/Socio-economic characteristics of the mothers 58
Table 4.2 Mothers knowledge of exclusive breastfeeding 60
Table 4.3 Factors that affect maternal breastfeeding practices 63
Table 4.4a Mothers practices on exclusive breastfeeding 67
Table 4.4b Mothers practices on exclusive breastfeeding 70
Table 4.4c Mothers practices on exclusive breastfeeding 74
Table 4.5 Mothers attitude on breastfeeding 78
Table 4.6 Infant feeding frequency 80
Table 4.7: Summary anthropometric measurement of the infants (0-12 months) 83
Table 4.7.1: Anthropometric measurement of the infants by sex 87
Table 4.7.2 Anthropometric measurement of the infants by sex 90
Table 4.8: the relationship between breastfeeding practices and anthropometry Measurement of the infants 94
CHAPTER 1
1.0 INTRODUCTION
Breastfeeding is feeding an infant or young child with breast milk directly from human breast (Kramer et al., 2001). Breastfeeding is an unequal way of providing food for the healthy growth and development of infant. It is also an integral part of the reproductive process with important implication for the health of the mother (Kramer et al., 2001). Breastfeeding is very useful both for the child and the mother. For the child, the breast milk is easy to digest; it is the most complete form of nutrition for the infants (WHO, 2007). Exclusive breastfeeding based on the WHO. (2004) definition refers to the practice of feeding only breast milk (including express breast milk) for six months. Other liquids and solid food are excluded. Colostrums, the yellowish sticky breast milk produced at the end of the pregnancy is recommended by the WHO as the perfect food for the new born and feeding should be initiated within the first hour after birth (Beneth and Brown 1996). According to a WHO. (2002) report, alternative to express milk from an infant’s own mother are the best milk from a healthy wet-nurse. Barbara. (2001) reported that in New York, illnesses in breast fed infant were milder and fewer and they are taken to the hospital less often. Kramer et al. (2001) revealed that exclusive breast feeding reduces infant mortality due to common childhood illness such as diarrhea or pneumonia and makes for a quicker recovery during illness.
In Nigeria, breastfeeding practices continue to fall well below the WHO/UNICEF recommendation for developing country. For instant, current percentage of children who are breastfed exclusively in Nigeria is 17% (UNICEF, 2015). Various factors associated with sub-optional breastfeeding practices have been identified in various settings. These include maternal characteristics such as age, mental status, occupation, educational level, antenatal and maternity health care (Black et al 2003).
Several factors for the different attitudes put forward by mothers in the course of breastfeeding which include; partner or friend family support (Carballo, 1991). Fear of inadequate milk supply (UNICEF, 2008). Ambivalent links of breastfeeding with sagging breast (Carballo, 1991). Socio cultural and psychological factors (Carballo, 1991). The mother’s partner plays an important in encouraging breast feeding. When partners support the decision, mothers are more likely to start and continue breastfeeding (Aminu and Agle, 2003). Clearly, educating those closest to the mother could change attitudes and promote breast feeding (Aminu et al, 2003), physical obstacles to breast feeding are rare, although most mothers quit before the recommended six months because of perceived difficulties (Aminu et al, 2003). Successful breastfeeding requires adequate nutrition and rest. This plus the support of all who care will help to enhance the well-being of mother and infants.
Anthropometric measurements are useful criteria for assessing nutritional status. It is one of the simplest and cost effective methods of assessment of growth and development especially in infants and children. Normally, anthropometric measurements are concerned with the measurements of the variation of physical dimensions and the gross composition of the human body at different age levels and degree of nutrition. Certainly, physical dimensions of the body are much influenced by nutrition particularly in the rapid growing period of infancy (Kamla-Raj, 2005). In infants, selected body measurements particularly the recumbent height (length, weight, head, chest and mid-upper-arm circumferences can provide index of nutritional well being and degree of impaired growth and development in infants and children.
Recently in the developing countries, anthropometry has become the conventional practical tool for evaluating the nutritional status of infants and children. This has been found necessary to reduce the aggressive effect of stunting and wasting occurring mostly at early stage in life due to chronic nutritional deficiencies presented by poor infant feeding practices and care (Brown et al,1995). According to Dewey et al. (2003), once stunting is present, it could remain for life and there may be no catch up for growth. He continued that if stunting is not addressed at earlier stage it could lock a child in a lower growth trajectory with a lower potential for future growth. This condition usually presents with ill consequences of impaired psychomotor development and long term deficit in mental performance in children.
Researchers have proved that breast milk remain the best start to life in all areas of infant development (UNICEF, 2008). Also, human milk is very different in composition from the most commonly used formula from bovine milk. Breast milk alone is the ideal nourishment for infants for the first 6 month of life, providing all the nutrients including vitamins and minerals an infant needs at this period of life. The nutrient specification in breast milk is well suited for infants. Breast milk is low in total protein and high in carbohydrates making it more digestible and less stressful on the immature kidney of infants In addition, each mammal produces milk that is nutritionally and immunologically tailored for its young one (Cameroun and Hofvander, 1983).
Human milk contains many immunological agents that protect infants against variety of infections. Studies in developing countries explained low incidence of diarrhea, respiratory tract infections, Otitis Media Effusion (OME), meniningitis, botulism, urinary tract infection and necrotizing enterocolitis in breastfed infants. This enhances general well being including anthropometrics profile in infants and children (Beneth et al, 1996).
Continued breastfeeding accompanied by sufficient quantities of nutritionally adequate, safe and appropriate complementary food maintains good nutritional status with proper growth and development of various body dimensions in early period of life. Bovine milk (formula) is associated with limited nutrients and improper specification and thus not recommended in the first year of life. Cow milk has higher concentration of protein and phosphorus, lower calcium to phosphorus ratio, limited iron, less essential fatty acid (EFA), Vitamin C and zinc than human milk. This may account for the increased renal solute load and occultic blood loss presenting iron deficiency and anaemia in infants fed cow milk supplemented with other nutrients in early periods of life (Beneth et al, 1996). Poor infant feeding practices particularly inadequate breastfeeding or early shift to bottle and complementary feeding is associated with high rate of infection and malnutrition resulting in undesirable anthropometric profile in infants and children.
1.1 STATEMENT OF PROBLEM
Breastfeeding has many advantages over any other form of feeding. It is cheap, convenient and encourages mother – infant bonding. Breast-milk contains anti-infective properties immunoglobulin A (LgA), lactotemin, an iron containing glycoprotein and lysozymes. Breastfeeding is best when done exclusively (WHO, 2004). This is because studies have shown that breastfed infants are more confident calm, more sensible and healthier than nonexclusively breastfed ones. Even adults who where breastfed as infants have better cognitive function than those not exclusively breastfed (Shechan et al, 2001).
The global initiative to promote exclusive breastfeeding is still a concern in Nigeria, and the increase at the global level is very modest. Unfortunately, breastfeeding is on the decline and exclusive breastfeeding rate is very low in many countries. In Nigeria it has been reported that the rate of exclusive breastfeeding ranges between 16% and 17% (UNICEF, 2015). This is as a result of an expensive venture. The practice becomes totally entrenched even amongst those who could barely afford it. Cow milk is best for cows and human breast milk is best for human babies. Early introduction of whole of cow’s milk is associated with increased risks of milk protein allergy, gastrointestinal blood loss, poor iron delivery, and overall poor nutritional status of the infant (Leah, 2007). However, infants are prone to stunted growth, retard mental development, low productivity, low resistance to diseases and infection, high morbidity and mortality rate, when good feeding practices are not encouraged.
WHO. (2002), advocated the promotion and support of breastfeeding. However, before this will be done, it is important to find out current practices and factors that imitate against the practices of appropriate breastfeeding, and more effort is required to promote extension practices of exclusive breastfeeding.
1.2 OBJECTIVES OF THE STUDY
1.2.1General Objective
The general objective is to assess the influence of maternal breastfeeding practices on the anthropometric status of their infants (0 – 12months) in Arochukwu L.G.A, Abia State.
1.2.2 Specific Objectives
• Assess the knowledge, attitude and practice of mothers towards exclusive breastfeeding.
• Assess the factors that influence maternal breastfeeding.
• Assess the nutritional status of infants using anthropometry.
• Assess the relationship between breastfeeding practices and anthropometric status of infants.
1.3 SIGNIFICANCE OF STUDY
At the end of this study the findings from this study will help to identify some factors that influence maternal breastfeeding practices on their infants (0 – 12months). This finding will provide information on the prevalence of exclusive breastfeeding practices in Arochukwu L.G.A. It will help the society to appreciate the benefits associated with breastfeeding which will propel them to encourage and support these practices. This findings will also determine how the practices affect the Anthropometric status of their infants (0 – 12months), some attitude towards breast feedings. It will provide information that will help the health workers, consultant in health centers to educate pregnant and lactating mothers on appropriate breastfeeding practices which will help to improve the children’s nutritional status. Also to enable the government to know their roles in enhancing appropriate breastfeeding practices.
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